By some measures, the Denver metro space has one of the vital aggressive hospital markets within the nation. Giant well being techniques duke it out yearly for supremacy within the multibillion-dollar market.
However now, two of these heavyweight well being techniques — regionally primarily based UCHealth and Utah-based Intermountain Healthcare — have determined to … cooperate? The techniques earlier this month introduced plans to type what is named a “clinically built-in community.”
Whereas that will sound just like the hospital giants are planning to mix assets on the scientific facet, it is truly extra akin to forming one big insurance coverage community. The well being techniques will stay separate, and they’re going to proceed to compete towards each other to draw sufferers.
The brand new community will deliver collectively roughly 700 main care physicians, tons of of clinics and dozens of hospitals — all obtainable and in community for customers whose medical health insurance contracts with the brand new clinically built-in community. And, not coincidentally, the techniques introduced that Intermountain’s SelectHealth insurance coverage plan will soar into the market in Colorado for Medicare customers in addition to individuals who purchase insurance coverage on their very own. SelectHealth will make the most of the brand new community.
UCHealth’s and Intermountain’s respective leaders mentioned the brand new clinically built-in community will enhance the standard of well being care that individuals obtain in Colorado whereas lowering the prices of that care.
“We’re excited to associate with Intermountain to advance these targets and to present Coloradans a brand new possibility for his or her medical health insurance that prioritizes value-based care,” Elizabeth Concordia, UCHealth’s president and CEO, mentioned in a press release saying the brand new community. “Collectively, we are going to assist enhance the general well being of the communities we serve.”
However shopper advocates query whether or not that can truly occur or whether or not that is one other play by giant well being techniques to get even bigger — and take extra money for themselves.
“In the event that they’re primarily utilizing this as negotiating energy or as a mechanism to shirk all different insurance coverage carriers, that is a priority,” mentioned Adam Fox, the deputy director of the Colorado Client Well being Initiative.
How the clinically built-in community would, um, work
The ability of the brand new community, in accordance with UCHealth’s Michael Cancro, is in its dimension.
Cancro is UCHealth’s chief technique officer and he additionally serves because the president of an already-existing UCHealth supplier community known as Coordinated Care Colorado. That community will merge with Intermountain’s Colorado High quality Care Community to type the brand new clinically built-in community. The brand new community will function as its personal firm.
Cancro mentioned this merger does one actually vital factor: It provides the brand new community sufficient sufferers to begin doing a little in-depth analyses and likewise present higher service.
“By bringing the organizations collectively, you could have a reasonably huge trove of knowledge in addition to the potential to look and establish these sufferers who’re rising dangers,” he mentioned.
The important thing to lowering prices whereas bettering care is to establish sufferers early whose well being is heading down the flawed path, Cancro mentioned. However, with a smaller pool of sufferers, he mentioned it may be tough to have sufficient information to know which alerts imply bother.
The affected person quantity of the brand new community means it can collect sufficient information to conduct extra exact evaluation, whereas additionally having the ability to rent extra specialists to try this work.
“Accessing information scientists, gaining access to giant sufficient datasets to have the ability to say that that is an indicator and this isn’t,” he mentioned. “The extra lives, the higher.”
The community may also have the ability to ship out alerts to folks, letting them know they should see a physician about a difficulty or giving them a nudge to return in for a checkup.
Cancro mentioned the community will initially supply care to greater than 300,000 sufferers. However Cancro mentioned the purpose is for extra insurers moreover SelectHealth to strike offers with the brand new community, that means it might deliver in additional sufferers. He mentioned it is also attainable that extra medical doctors’ teams and medical suppliers might be a part of the community.
Client teams hear echoes of hospital mergers
Client advocates are skeptical of all these guarantees. To them, this sounds an terrible lot like what hospital techniques have mentioned for years when shopping for up native hospitals or merging with different techniques.
As in lots of different states, Colorado’s well being care system has been consolidating. And never at all times to the advantage of the affected person’s pocketbook.
“Hospital consolidation is probably going the most important driver of costs and working margins in Colorado’sEntrance Vary counties,” a 2020 report from the Middle for Financial and Coverage Analysis acknowledged.
The brand new clinically built-in community is not an actual analogue to a hospital merger. However it has sufficient similarities that folk like Robert Smith, the manager director of the Colorado Enterprise Group on Well being, will consider its guarantees of decrease costs and higher care solely when he truly sees it. Smith has lengthy been a champion of lowering well being care prices in Colorado.
“There is no proof within the literature that these mergers enhance outcomes,” Smith mentioned. “They’ve all mentioned that. However there isn’t any proof.”
What’s SelectHealth and when will it launch?
Intermountain is a brand new participant in Colorado’s well being care market. Final yr, it merged with SCL Well being, giving it a presence in Colorado for the primary time. SelectHealth is Intermountain’s insurance coverage arm — and, like Intermountain and UCHealth, it’s nonprofit.
SelectHealth hopes to have plans obtainable on the market in Colorado on the finish of this yr for protection that might start in 2024. It intends to supply Medicare Benefit plans, in addition to insurance coverage within the state’s particular person insurance coverage market, together with through the Join for Well being Colorado insurance coverage alternate.
UCHealth’s Cancro mentioned SelectHealth will not promote insurance coverage in each Colorado county. As an alternative, it can launch in round 16 to 18 counties, he mentioned. These will largely be alongside the Entrance Vary, to match UCHealth’s and Intermountain’s footprints for his or her well being techniques.
First, although, SelectHealth should obtain approval from the state’s Division of Insurance coverage. The division is reviewing SelectHealth’s utility and can announce a call later this yr.
“The DOI is simply studying about this three way partnership, and we might want to additional analyze what it entails and what impression it can have on the state’s medical health insurance market,” Colorado Insurance coverage Commissioner Michael Conway mentioned in a press release. “However, this announcement is a transparent indication that Colorado continues to be a spot the place medical health insurance corporations wish to come to, and that they wish to do enterprise in our particular person medical health insurance market.”
Regardless of the apparent inside connection, leaders of UCHealth and Intermountain mentioned SelectHealth will not be getting a sweetheart deal when it contracts with the brand new clinically built-in community, or CIN, because the executives check with it.
“The CIN will deal with SelectHealth identical to all payers right here,” Mark Korth, Intermountain Healthcare’s regional president, mentioned in a press release. “Any plan that aligns with the CIN’s targets of making certain a greater affected person expertise and well being outcomes whereas reducing prices will likely be thought of a helpful associate.”
